The word endometriosis comes from the Greek ‘endos’ meaning inside, ‘metra’ meaning womb, while the suffix ‘-osis’ means disease.
What is endometriosis?
Endometriosis is a complex disease that can recur and impact women for life, in some cases, and causes chronic pain, sometimes being very difficult to live with daily. It can affect all women and girls of childbearing age, regardless of race and ethnicity and can be hereditary. In the UK alone, it affects around 1.5 million women, while it is believed that it affects 5-10% of women in general.
Endometriosis, which has been a disease long ignored, is a condition where tissue similar to the lining of the uterus (womb) starts to grow outside the uterus, such as around the ovaries and fallopian tubes. Endometriosis will be influenced by hormonal changes that occur during each menstrual cycle.
The pathophysiology of endometriosis involves many hypotheses (metaplasia, induction, metastatic, immunological, genetic, epigenetic and environmental, stem cells, etc.). It is impossible to understand this disease without taking into account the regurgitation theory known as “implantation theory”. During menstruation, under the effect of uterine contractions, some of the blood is regurgitated through the tubes and into the abdominal-pelvic cavity. The majority of endometriosis sufferers would relate to this theory.
This blood contains endometrial cells, fragments of uterine lining which, instead of being destroyed by the immune system, will implant themselves and then, under the effect of subsequent hormonal stimulation, proliferate on neighbouring organs such as the peritoneum, ovaries, fallopian tubes, intestines, bladder, ureters, and diaphragm.
Endometriosis is therefore responsible for disabling pelvic pains and also, in some cases, for infertility. These symptoms have a major impact on the quality of life of people with the disease with a significant impact not only on their personal and married life, but also on their professional and social life.
It is even customary to say that there is not one but “some” endometriosis because this disease does not develop in the same way from one person to another. There are no certainties concerning endometriosis except that it takes different forms in different places in different proportions from person to person.
In a third of all cases, endometriosis does not develop, stagnates, or even regresses thanks to treatment (medical or surgical) or spontaneously, especially for superficial forms. However, some endometriosis will develop into severe forms, the management of which is complex and involves a multidisciplinary healthcare team. This is the advantage of a diagnosis as early as possible, to avoid a potential worsening of symptoms and a deterioration in quality of life.
Types of endometriosis
Today, healthcare professionals no longer classify endometriosis as "stages" I - II - III - IV. They are now referring to three types of endometriosis:
Superficial (or peritoneal lesion) endometriosis - which indicates the presence of implants of ectopic endometrium located on the surface of the peritoneum. This is the most common kind.
Ovarian (or ovarian lesion) endometriosis - ovarian endometrioma is an ovarian cyst characterised by its chocolate-coloured fluid content.
Deep pelvic (or sub-peritoneal) endometriosis - corresponds to lesions that infiltrate deeper than 5 mm below the surface of the peritoneum. Deep endometriosis can typically affect the uterosacral ligaments (50% of cases), posterior vaginal cul-de-sac (15%), intestines (20-25%), bladder (10%), ureters (3%) and beyond pelvic cavity, sigmoid, right colon, appendix and terminal ileum for the most frequent locations.
Some women might not notice any symptoms. However, these can include:
Back pain during your period.
Severe menstrual cramps.
Pain when pooping or peeing, especially during your period.
Unusual or heavy bleeding during periods.
Blood in your stool or urine.
Diarrhoea or constipation.
Fatigue that will not go away.
Trouble getting pregnant.
There is currently no cure for endometriosis and treatment generally include medications or surgery. If you think you suffer from endometriosis, please consult your doctor.
In summary, endometriosis is a disease that can be hereditary and affect some girls and women regardless of age and ethnicity. It can be very painful and can have a strong impact on the sufferer’s daily life. There is no correlation between the intensity of pain or the type of endometriosis, and superficial endometriosis can be very painful due to the presence of many nerves.